Ideas to Action:

Independent research for global prosperity

Publications

 

December 16, 2013

Clear Direction for a New Decade: Priorities for PEPFAR and the Next US Global AIDS Coordinator

PEPFAR is at a critical turning point in its decade-long existence. The next US Global AIDS Coordinator is uniquely positioned to set the course for the program’s future. A change in leadership at the President’s Emergency Plan for AIDS Relief creates an opportunity to ask questions about the organization and reflect in more general terms on the US response to the global AIDS epidemic.

October 23, 2013

HIV/AIDS Intervention Packages in Five Countries: A Review of Budget Data

More than ever, global health funding agencies must get better value for money from their investment portfolios; to do so, each agency must know the interventions it supports and the sub-populations targeted by those interventions in each country. In this study we examine the interventions supported by two major international AIDS funders: the Global Fund to Fight AIDS, Tuberculosis, and Malaria (‘Global Fund’) and the President’s Emergency Plan for AIDS Relief (PEPFAR).

October 15, 2013

Here’s the Best Thing the United States Has Done in Afghanistan

Afghanistan’s progress against mortality reflects the success of providing health aid that differed radically from the bulk of American aid to Afghanistan during the war. The USAID program that contributed to the decline was a multilateral effort coordinated by Afghanistan’s own Ministry of Public Health. Results were verified by random sampling, and some funding was linked to measures of performance. This internal policy experiment, however, was destined to provoke resistance. More surprising is the source of resistance to an aid program that attempted to stop simply throwing money at a problem and focus on building sustainable systems: auditors.

August 22, 2013

Grant Performance and Payments at the Global Fund

Performance-based financing can be used by global-health funding agencies to improve program performance and thus value for money. The Global Fund to Fight AIDS, Tuberculosis and Malaria was one of the first global-health funders to deploy a performance-based financing system. However, its complex, multistep system for calculating and paying on grant ratings has several components that are subjective and discretionary. We aimed to test the association between grant ratings and disbursements, an indication of the extent to which incentives for performance are transmitted to grant recipients. 

August 7, 2013

Data Set for The Financial Flows of PEPFAR: A Profile

This is the data set for Policy Paper 27 , “The Financial Flows of PEPFAR: A Profile,” in which Victoria Fan, Rachel Silverman, Denizhan Duran, and Amanda Glassman track the financial flows of the President's Emergency Plan for AIDS Relief (PEPFAR) from donor agencies via intermediaries and to pr

Victoria Fan , Denizhan Duran and Amanda Glassman
July 29, 2013

The Financial Flows of PEPFAR: A Profile

Little is known about the President’s Emergency Plan for AIDS Relief (PEPFAR) financial flows within the United States (US) government, to its contractors, and to countries. We track the financial flows of PEPFAR – from donor agencies via intermediaries and finally to prime partners. We reviewed and analyzed publicly available government documents; a Center for Global Development dataset on 477 prime partners receiving PEPFAR funding in FY2008; and a cross-country dataset to predict PEPFAR outlays at the country level. We present patterns in Congressional appropriations to US government implementing agencies; the landscape of prime partners and contractors; and the allocation of PEPFAR funding by disease burden as a measure of country need.

July 15, 2013

When Is Prevention More Profitable than Cure? The Impact of Time-Varying Consumer Heterogeneity - Working Paper 334

We argue that in pharmaceutical markets, variation in the arrival time of consumer heterogeneity creates differences between a producer’s ability to extract consumer surplus with preventives and treatments, potentially distorting R&D decisions. If consumers vary only in disease risk, revenue from treatments—sold after the disease is contracted, when disease risk is no longer a source of private information—always exceeds revenue from preventives. The revenue ratio can be arbitrarily high for sufficiently skewed distributions of disease risk. Under some circumstances, heterogeneity in harm from a disease, learned after a disease is contracted, can lead revenue from a treatment to exceed revenue from a preventative. Calibrations suggest that skewness in the U.S. distribution of HIV risk would lead firms to earn only half the revenue from a vaccine as from a drug. Empirical tests are consistent with the predictions of the model that vaccines are less likely to be developed for diseases with substantial disease-risk heterogeneity

Michael Kremer and Christopher M. Snyder
June 10, 2013

The Early Success of India’s Health Insurance for the Poor, RSBY

In just five years, India’s Rashtriya Swasthya Bima Yojana (RSBY, translated as “National Health Insurance Programme”) has expanded health-care access. Where dozens of “microinsurance” and NGO pilots failed to scale up, RSBY has already provided more than 110 million people (almost 10 percent of India’s population) with heavily subsidized health insurance, providing up to US$550 annually to finance secondary hospital care. Although the research evidence on RSBY is still developing, early results are encouraging: increased utilization and hospitalization; some indication of reduced out-of-pocket payments for healthcare; and a means of identification with a clearly linked entitlement. While RSBY still faces challenges, particularly on the quality of care of increased hospitalization rates, RSBY has aligned incentives for both public and private hospitals to deliver better care.

In this essay, Victoria Fan tells the story of how RSBY came into being under the leadership of Anil Swarup—whom she describes as an “unassuming officer of the Indian Administrative Service”—and outlines the program’s early successes and opportunities for future progress.

April 24, 2013

Impact of Conditional Cash Transfers on Maternal and Newborn Health

The authors carry out a systematic review of studies on CCTs that report maternal and newborn health outcomes, including studies from eight countries. We find that CCTs have increased antenatal visits, skilled attendance at birth, delivery at a health facility, and tetanus toxoid vaccination for mothers, and reduced the incidence of low birth weight. The programs have not had a significant impact on fertility or Caesarean sections while impact on maternal and newborn mortality has not been well documented thus far.

Amanda Glassman , Denizhan Duran and Marge Koblinsky
March 11, 2013

The Moral Imperative toward Cost-Effectiveness in Global Health

In this essay, Toby Ord explores the moral relevance of cost-effectiveness, a major tool for capturing the relationship between resources and outcomes, by illustrating what is lost in moral terms for global health when cost-effectiveness is ignored.

Toby Ord